Results from a survey investigating the clinical pathways of epileptic seizures and status epilepticus (SE) determine high variability among hospitals in Italy (Neurol Sci. 2020;41[6]:1571-1575. doi:10.1007/s10072-020-04270-3).
“National Institute for Health and Care Excellence (NICE) epilepsy guidelines recommend that although initial evaluation of the patient may be undertaken by a primary care physician, all adults and children having a first seizure should be seen as soon as possible by a specialist involved in the management of the epilepsies. However, this is far from being accomplished since such patients may access emergency departments in hospitals where epilepsy specialists are not available and where there are no neurological guards,” explained Gaetano Zaccara, MD, Regional Health Agency of Tuscany, Florence, Italy, and colleagues.
“Therefore, clinicians with a different expertise are often in charge of taking critical decisions regarding their diagnosis and initiation of therapy and very few studies have investigated how early these patients are referred to neurologists or epileptologists and how guideline recommendations are applied in the clinical practice,” they continued.
Dr Zaccara and colleagues conducted a survey to examine how emergency and subsequent hospital pathways in Italy are used to manage patients with epileptic seizures or SE.
The survey included neurologists, epileptologists, emergency room physicians, and intensivists, actively involved in treating seizures in hospitals of different sizes in Italy. The questionnaire included questions aimed at describing how patients with seizures or SE are managed in their hospitals.
Out of 180 clinicians asked to fill in the questionnaire, 177 completed the survey. Only 35% of the participants indicated that patients with epilepsy in their hospital were managed by epileptologists. The percentages are even lower for patients with acute seizures (21%) and SE (16%).
Most participants cited organizational issues and lack of appropriate diagnostic, therapeutic, and assistance pathways PDTAs for the absence of specialist management.
“In conclusion, patients who present at the hospital with repeated seizures or SE need to be managed by a network of professionals and services,” concluded Dr Zaccara and colleagues.
“For optimal treatment, these professionals should interact with each other and an appropriate sequence of interventions should be laid out in a structured PDTA,” they added.—Lisa Kuhns
